Active NPI
Matthew J Ouellette, DO
- Family Medicine Physician
- Wayne, MI
National Provider Identifier
1063932788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5151011930
- Practice address
- 33155 Annapolis St
Wayne, MI 48184-2405 - Phone
- (734) 467-2483
- NPI assigned
- Jun 23, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5151011930 | MI | Primary |
Addresses
Primary practice location
33155 Annapolis St
Wayne, MI 48184-2405
Mailing address
2475 McDougall Street
Suite 245
Windsor, ONTARIO N8X3N9
CA
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5151011930 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1063932788",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "2475 MCDOUGALL STREET",
"address_2": "SUITE 245",
"city": "WINDSOR",
"state": "ONTARIO",
"postal_code": "N8X3N9"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33155 ANNAPOLIS ST",
"city": "WAYNE",
"state": "MI",
"postal_code": "481842405",
"telephone_number": "734-467-2483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OUELLETTE",
"first_name": "MATTHEW",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-23",
"last_updated": "2022-07-21",
"certification_date": "2020-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5151011930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.